Upcoming Changes to the Claim Review Form

Effective Jan. 1, 2017, the paper Claim Review Form for Blue Cross Blue Shield TX (BCBSTX) will be updated to help expedite the process for providers when submitting written claim inquiries.

The most efficient way to request a claim review for specific inquiries is electronically through the Claim Inquiry Resolution (CIR) tool, which is accessible through the Availity^TMWeb portal  . For providers who need to submit claim review requests via paper, the current process involves using one universal Claim Review Form for several different reasons, such as paper corrected claims, requested medical records, claim check denials, or even basic claim reviews.

BCBSTX is streamlining the paper claim review process to help facilitate more accurate processing of incoming requests. As of Jan. 1, 2017, written claim inquiries must be submitted on one of the specific Claim Review Forms listed below. Each Claim Review Form must include the BCBSTX claim number (the Document Control Number, or DCN), along with the key data elements specified on the forms. These forms will be available later this month on our Provider website in the Education and Reference Center/Forms section.

Checking claim status online is strongly encouraged prior to submitting claim review requests. The most effective way to determine claim status is electronically through your preferred Web vendor, or by using the Availity Claim Research Tool. Making use of electronic options allows retrieval of needed information in near real-time.

As indicated above, Availity users have access to the Claim Inquiry Resolution tool, which delivers a method of online assistance for specific inquiries on finalized claims. This tool is designed to help save you time by reducing the amount of calls and written inquiries submitted.

To learn more about these and other electronic options, visit the Provider Tools section in our online Education and Reference Center. For personalized online training regarding electronic tools, contact our Provider Education Consultants at PECS@bcbstx.com.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.